一种差异模型：与 COVID-19 感染相关的风险因素。
A model of disparities: risk factors associated with COVID-19 infection.
机构信息
Providence Health System (Providence), 1801 Lind Avenue S.W. Valley Office Park - Morin Bldg, 1st Floor Renton, Washington, 98057-9016, USA.
Providence Health System (Providence) and Ayin Health Solutions, 1801 Lind Avenue S.W. - Valley Office Park - Gamelin Bldg, Executive Office, Renton, Washington, 98057-9016, USA.
出版信息
Int J Equity Health. 2020 Jul 29;19(1):126. doi: 10.1186/s12939-020-01242-z.
BACKGROUND
By mid-May 2020, there were over 1.5 million cases of (SARS-CoV-2) or COVID-19 across the U.S. with new confirmed cases continuing to rise following the re-opening of most states. Prior studies have focused mainly on clinical risk factors associated with serious illness and mortality of COVID-19. Less analysis has been conducted on the clinical, sociodemographic, and environmental variables associated with initial infection of COVID-19.
METHODS
A multivariable statistical model was used to characterize risk factors in 34,503cases of laboratory-confirmed positive or negative COVID-19 infection in the Providence Health System (U.S.) between February 28 and April 27, 2020. Publicly available data were utilized as approximations for social determinants of health, and patient-level clinical and sociodemographic factors were extracted from the electronic medical record.
RESULTS
Higher risk of COVID-19 infection was associated with older age (OR 1.69; 95% CI 1.41-2.02, p < 0.0001), male gender (OR 1.32; 95% CI 1.21-1.44, p < 0.0001), Asian race (OR 1.43; 95% CI 1.18-1.72, p = 0.0002), Black/African American race (OR 1.51; 95% CI 1.25-1.83, p < 0.0001), Latino ethnicity (OR 2.07; 95% CI 1.77-2.41, p < 0.0001), non-English language (OR 2.09; 95% CI 1.7-2.57, p < 0.0001), residing in a neighborhood with financial insecurity (OR 1.10; 95% CI 1.01-1.25, p = 0.04), low air quality (OR 1.01; 95% CI 1.0-1.04, p = 0.05), housing insecurity (OR 1.32; 95% CI 1.16-1.5, p < 0.0001) or transportation insecurity (OR 1.11; 95% CI 1.02-1.23, p = 0.03), and living in senior living communities (OR 1.69; 95% CI 1.23-2.32, p = 0.001).
CONCLUSION
sisk of COVID-19 infection is higher among groups already affected by health disparities across age, race, ethnicity, language, income, and living conditions. Health promotion and disease prevention strategies should prioritize groups most vulnerable to infection and address structural inequities that contribute to risk through social and economic policy.
背景
截至 2020 年 5 月中旬，全美已有超过 150 万例（SARS-CoV-2）或 COVID-19 病例，随着大多数州重新开放，新确诊病例持续上升。先前的研究主要集中在与 COVID-19 严重疾病和死亡率相关的临床风险因素上。对于与 COVID-19 初始感染相关的临床、社会人口学和环境变量的分析较少。
方法
使用多变量统计模型对 2020 年 2 月 28 日至 4 月 27 日期间美国普罗维登斯健康系统（美国）34503 例实验室确诊的 COVID-19 阳性或阴性感染病例中的危险因素进行了特征描述。利用公共数据近似评估健康的社会决定因素，并从电子病历中提取患者水平的临床和社会人口学因素。
结果
COVID-19 感染的风险更高与年龄较大（OR 1.69；95%CI 1.41-2.02，p<0.0001）、男性（OR 1.32；95%CI 1.21-1.44，p<0.0001）、亚洲种族（OR 1.43；95%CI 1.18-1.72，p=0.0002）、黑种人/非裔美国人种族（OR 1.51；95%CI 1.25-1.83，p<0.0001）、拉丁裔（OR 2.07；95%CI 1.77-2.41，p<0.0001）、非英语语言（OR 2.09；95%CI 1.7-2.57，p<0.0001）、居住在经济不安全的社区（OR 1.10；95%CI 1.01-1.25，p=0.04）、空气质量差（OR 1.01；95%CI 1.0-1.04，p=0.05）、住房不安全（OR 1.32；95%CI 1.16-1.5，p<0.0001）或交通不安全（OR 1.11；95%CI 1.02-1.23，p=0.03）、居住在老年人生活社区（OR 1.69；95%CI 1.23-2.32，p=0.001）有关。
结论
在年龄、种族、族裔、语言、收入和生活条件方面已经受到健康差异影响的群体中，COVID-19 感染的风险更高。健康促进和疾病预防策略应优先考虑最容易感染的群体，并通过社会和经济政策解决导致感染风险的结构性不平等问题。
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